USING CONTINGENCY MANAGEMENT TO PROMOTE ADHERENCE TO SMOKING CESSATION TREATMENT AMONG HOSPITALIZED SMOKERS

利用应急管理促进住院吸烟者坚持戒烟治疗

• 批准号: 10672234
• 负责人: Erica Nichols Cruvinel
• 金额: $ 17.19万
• 依托单位: UNIVERSITY OF KANSAS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10672234
• 关键词: Abstinence; Address; Adherence; Area; Behavior; Behavioral; Biochemical; Caring; Clinical; Clinical Trials; Combined Modality Therapy; Counseling; Data; Development; Future; Goals; Health; Hospitalization; Hospitals; Incentives; Inpatients; Intervention; Interview; Kansas; Knowledge; Length of Stay; Link; Medicaid; Medical center; Mentors; Methods; Morbidity - disease rate; Outcome; Participant; Patients; Pharmaceutical Preparations; Pharmacotherapy; Postdoctoral Fellow; Procedures; Randomized; Randomized, Controlled Trials; Reporting; Research; Research Personnel; Smoker; Smoking; Smoking Cessation Intervention; Structure; Surveys; System; Telefacsimile; Telephone; Testing; Tobacco; Tobacco Dependence; Training; Underserved Population; Universities; acceptability and feasibility; alcohol tobacco and other drug use; arm; behavior change; behavioral clinical trial; care delivery; career; clinical practice; contingency management; design; effective therapy; efficacy study; efficacy trial; evidence base; experience; feasibility testing; financial incentive; follow-up; improved; innovation; intervention refinement; mHealth; medication compliance; mortality; nicotine gum; novel; novel strategies; patient engagement; payment; pill; quitline; randomized trial; recruit; remote delivery; research study; skills; success; text messaging intervention; therapy development; tobacco cessation intervention; tobacco user; varenicline; wasting

PROJECT SUMMARY/ABSTRACT Each year, nearly 4 million smokers are hospitalized in the US, creating an important opportunity to initiate to- bacco cessation treatment. However, smoking cessation treatment started in the hospital must continue at least 1 month post-discharge to be effective. Many hospitals refer smokers to state-sponsored tobacco quitlines to provide counseling follow up. A recent clinical trial found that varenicline use initiated during the hospital stay in combination with post-discharge quitline support increased smokers’ likelihood of quitting by 78%. Nevertheless, most inpatient smokers rarely actually register with the quitline, and those who do register participate in very few sessions. Furthermore, most smokers never fill their prescriptions for post-discharge cessation medications. Novel approaches are needed to engage hospitalized smokers in medication and counseling to increase their odds of quitting. Contingency management (CM) intervention provides financial incentives contingent upon ob- jective evidence of behavior change and is an effective approach to increase engagement in quitline calls and to increase rates of compliance with nicotine gum. Critical gaps remain in our knowledge about how best to deploy CM. CM has not been tested for increasing treatment engagement post-hospitalization. Remote delivery of CM via mobile health (mHealth) has not been tested for smoking cessation treatment. More broadly, CM approaches for concurrently incentivizing combined interventions (such as pharmacotherapy + behavioral sup- port) are lacking. The purpose of the proposed research is to develop and test the feasibility and preliminary efficacy of an mHealth-delivered CM intervention to increase hospitalized smokers’ post-discharge engagement in counseling and pharmacotherapy. The proposed research study has the following specific aims: 1) develop a text-based intervention (CounsCM+MedCM) to remotely incentivize engagement in quitline calls and varenicline utilization among post-discharged smokers; 2) to use mixed methods to understand strengths, weaknesses, and areas for improvement of CounsCM+MedCM; 3) to evaluate the feasibility, acceptability, and preliminary efficacy of CounsCM+MedCM compared to noncontingent “yoked” control (NCYC), in a pilot randomized controlled trial. Dr. Cruvinel is a postdoctoral associate at the University of Kansas Medical Center with experience and training in interventions to address tobacco, alcohol and other drug use. Dr. Cruvinel’s career goal is to reduce tobacco- related morbidity and mortality of hospitalized smokers through novel systems of evidence-based care delivery, with an emphasis on mHealth interventions for underserved populations. The primary training goals of this pro- posal are to gain skills in pharmaco-and behavioral clinical trials, mHealth intervention development, and to develop expertise in CM interventions. The results of the proposed research and training plans will facilitate Dr. Cruvinel's development as an independent investigator and provide preliminary data for a future large-scale efficacy study.

项目摘要/摘要 每年，在美国，近400万吸烟者都住院，创造了一个重​​要的机会来启动 - BACCO停止处理。但是，在医院开始的戒烟治疗必须至少继续 入院后1个月有效。许多医院将吸烟者推荐给国家赞助的烟草戒烟。 提供后续咨询。最近的一项临床试验发现，在医院住宿期间启动的Varenicline使用 结合入院后的戒烟线支持吸烟者戒烟的可能性增加了78％。尽管如此， 大多数住院吸烟者实际上很少在Quitline注册，而那些注册的人参加了极少的人 会议。此外，大多数吸烟者从不填充其处方，以进行放电后戒烟药物。 需要采用新颖的方法来让住院的吸烟者进行药物和咨询以增加他们的 安静的几率。应急管理（CM）干预提供了经济激励措施，包括 行为改变的证据，是增加参与Quitline呼叫和的有效方法 提高遵守尼古丁口香糖的速度。关键的差距仍然是我们关于如何最好的知识 部署CM。 CM尚未通过增加院后治疗参与度的测试。远程交付 通过移动健康（MHealth）的CM尚未进行戒烟治疗的测试。更广泛的是CM 同时增加综合干预措施的方法（例如药物治疗 +行为sup- 端口）缺乏。拟议的研究的目的是发展和测试可行性和初步 MHealth授予CM干预的功效以增加住院吸烟者的入院后参与度 在咨询和药物疗法中。拟议的研究具有以下具体目的：1）开发 基于文本的干预措施（Counscm+MedCM），以激励参与Quitline呼叫和varinicline 释放后吸烟者的利用； 2）使用混合方法来了解优势，劣势和 改善Counscm+MedCM的区域； 3）评估可行性，可接受性和初步效率 在一项试验随机对照试验中，与非偶然的“ yoked”对照（NCYC）相比，Counscm+MedCM的属性。 Cruvinel博士是堪萨斯大学医学中心的博士后同学，经验和培训 在解决烟草，酒精和其他毒品的干预措施中。 Cruvinel博士的职业目标是减少烟草 - 相关的发病率和住院吸烟者的死亡率通过新型的循证护理交付系统， 重点是服务不足人群的MHealth干预措施。这个亲培训目标的主要培训目标 POSAL将获得药物和行为临床试验，MHealth干预开发的技能，并 开发CM干预方面的专业知识。拟议的研究和培训计划的结果将有助于博士。 Cruvinel作为独立研究者的发展，并为未来的大规模提供初步数据 功效研究。